*NURSING > DISCUSSION POST > NR 661 Week 4 VISE Assessment,Familiarize Yourself LATEST 2022-2023 (All)

NR 661 Week 4 VISE Assessment,Familiarize Yourself LATEST 2022-2023

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Know presentation, DX and Management Diagnoses List 1. Acute bronchitis- DESCRIPTION Acute cough due to inflammation of the bronchioles, bronchi, and trachea; usually follows an upper respiratory... infection or exposure to a chemical irritant. ETIOLOGY  Adenovirus  Rhinovirus  Influenza A and B  Parainfluenza RISK FACTORS  Upper respiratory infection  Air pollutants  Smoking and/or secondary exposure  Reflux esophagitis  Allergy  Chronic obstructive pulmonary disease  Acute and chronic sinusitis  Infants  Older adults  Immunosuppression ASSESSMENT FINDINGS  Cough: dry and nonproductive, then productive; may be purulent  URI symptoms  Fatigue  Fever due to bacterial infection; more common in smokers and patients with COPD  Fever due to viral cause (unusual after first few days)  Burning sensation in chest  Crackles, wheezes  Chest wall pain DIFFERENTIAL DIAGNOSIS  Pneumonia  Tuberculosis  Asthma DIAGNOSTIC STUDIES  Decision criteria for chest radiographs: tachypnea, hypoxia, fever, abnormal lung exam  Only consider chest X-ray if high index of suspicion for pneumonia or superimposed heart failure  Consider PPD: expect negative results  PREVENTION  Smoking cessation  Avoid known respiratory irritants  Treat underlying conditions that contribute to risk (asthma, gastroesophageal reflux disease, etc.)  Influenza immunization for high-risk populations NONPHARMACOLOGIC MANAGEMENT  Increase fluid intake  Use humidifier  Rest  Smoking cessation  Consider honey in children older than 1 year  Patient education about disease, treatment, expected cause of cough, and emergency actions PHARMACOLOGIC MANAGEMENT  Cough suppressants for nighttime relief  Avoid antihistamines  Antibiotics if organism is bacterial  Antivirals if influenza diagnosed  Decongestants and antihistamines are ineffective unless sinusitis or allergy is underlying  Bronchodilators if wheezing or prior history of asthma Although antibiotics are commonly prescribed, they are NOT recommended. ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT Class Drug Generic name (Trade name®) Dosage How Supplied Comments Cough Suppressants Suppress cough in the medullary center of the brain dextromethorphan/guaifenesi n Adult: 10 mL q 4 hr Max: 4 doses in 24 hours Children 6-12 years: 5 mL q 4-6 hr; Max: 4 doses in 24 hr Children <6 years: not recommended  Do not use if taking an MAO inhibitor or for 2 weeks after stopping an MAO inhibitor  Contraindicated in Parkinson’s disease  Potential drug interaction with some SSRIs  Avoid in patients who are having difficulty clearing Robitussin DM secretions various generics Dextromethorphan 10 mg/5 mL Guaifenesin 100 mg/5 mL [Show More]

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